Aortic Unfolding Determined Using Non-Contrast Cardiac Computed Tomography: Correlations with Age and Coronary Artery Calcium Score

Lee, Ji Won; Hur, Jin; Kim, Young Jin; Lee, Hye Jeong; Nam, Ji Eun; Kim, Hee Yeong; Hong, Yoo Jin; Ko, Seok Min; Kim, Tae Hoon; Choi, Byoung Wook

doi:10.1371/journal.pone.0095887

Cited by 7 publications

(12 citation statements)

References 35 publications

(45 reference statements)

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“…Lee et al measured the straight‐line “longest distance between the ascending and descending aortas” in 219 adults who underwent CAC scanning as part of routine health screening 21. This metric, which they called “unfolding,” is essentially AAW plus the radii of the 2 limbs of the aorta in the plane of main pulmonary artery bifurcation.…”

Section: Discussionmentioning

confidence: 99%

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

Chuang

Gona

Qazi

et al. 2018

JAHA

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BackgroundWe sought to determine whether increased aortic arch width (AAW) adds to standard Framingham risk factors and coronary artery calcium (CAC) for prediction of incident adverse cardiovascular disease (CVD) events in community‐dwelling adults.Methods and ResultsA total of 3026 Framingham Heart Study Offspring and Third Generation cohort participants underwent noncontrast multidetector computed tomography from 2002 to 2005 to quantify CAC. We measured AAW as the distance between the centroids of the ascending and descending thoracic aorta, at the level of main pulmonary artery bifurcation or the right pulmonary artery. We determined sex, age group, and body size specific cut points for high (≥90th percentile) AAW from a healthy referent group (N=1471) and dichotomized AAW as high or not high across all study participants. Clinical covariates were obtained at Offspring cycle 7 (1998–2001) or Third Generation cycle 1 (2002–2005) examinations. The primary CVD outcome was a composite of myocardial infarction, coronary insufficiency, cerebrovascular accident, first hospitalization for heart failure, or CVD death. Cox proportional hazards models were used to estimate hazard ratio of high AAW on time‐to‐incident CVD after adjustment for Framingham risk factors and CAC. Net reclassification improvement was used to assess the effect of adding AAW to the baseline Framingham risk factor+CAC model. A total of 2826 participants (aged 51±11 years, 48% women) had complete covariates and were free of CVD at multidetector computed tomography. Over a median 8.9 years of follow‐up, there were 135 incident CVD events. High AAW was independently predictive of CVD events (hazard ratio, 1.55; P=0.032) and appropriately reclassified participants at risk: net reclassification improvement, 0.31 (95% confidence interval, 0.15–0.48).Conclusion AAW augments traditional CVD risk factors and CAC for prediction of incident adverse CVD events among community‐dwelling adults.

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Section: Discussionmentioning

confidence: 99%

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

Chuang

Gona

Qazi

et al. 2018

JAHA

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“…AU was defined as the longest distance from the ascending aorta to the descending aorta at the level of the pulmonary artery bifurcation on an axial CT image because this landmark is easy to define anatomically, rendering it reproducible ( Fig. 1 ) ( 3 ). Systematic measurements of AU were performed by two blinded radiologists with different degrees of experience: reader 1 was a resident with 1 year of experience, and reader 2 was a radiologist with 7 years of experience in cardiac imaging.…”

Section: Methodsmentioning

confidence: 99%

“…Aortic unfolding (AU) is a term used to describe the widened mediastinum on chest radiographs. This change occurs with aging and generally reflects proximal aortic dilation, aortic arch widening, and decreased curvature ( 3 ). In addition, it implies aortic degeneration and is associated with hypertension ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…A recent study evaluated AU defined using the aortic width on non-contrast electrocardiography (ECG)-synchronized cardiac CT. AU was associated with age, body surface area (BSA), and hypertension, and was positively associated with the coronary artery calcium (CAC) score, a well-established surrogate marker of cardiovascular risk ( 3 ). However, that study included a relatively small sample size.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Unfolding Measurement Using Non-Contrast Cardiac CT: Normal Range of Low-Risk Subjects

이

최

2022

J Korean Soc Radiol

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Purpose This study aimed to assess the factors influencing aortic unfolding (AU) defined by aortic width on coronary artery calcium (CAC) scan and determine the normal limits for AU. Materials and Methods In this retrospective study, we measured AU in 924 asymptomatic subjects who underwent CAC scanning during routine health screening from June 2015 to June 2018. Multivariate regression analysis was used to evaluate the factors influencing AU. After the exclusion of subjects with risk factors associated with AU, 283 subjects were included in the analysis of normal values of AU. Mean AU, standard deviation, and upper normal limit were calculated. Results Sex, age, CAC score, body mass index, body surface area, hypertension, left ventricular hypertrophy, plasma creatinine, and smoking were significantly associated with AU. The mean AU was 102.2 ± 12.8 mm for men and 93.1 ± 10.7 mm for women. AU increased with advancing age (9.6 mm per decade). Conclusion AU determined from a single measurement on CAC scans was associated with cardiovascular risk factors. The normal limits of AU were defined by age, sex, and body surface area in low-risk subjects in this study.

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“…Aortic unfolding -independent of traditional risk factors-is studied to be positively associated with CAC. 64 Aortic unfolding finding on chest radiograph should be used as an indication for detection of subclinical atherosclerosis and measurement of coronary artery calcium. More research should be done on the relationship of CAC with aortic unfolding to use aortic unfolding as an indication of CAC detection and predictor of cardiovascular risks.…”

Section: K) Aortic Unfoldingmentioning

confidence: 99%

Coronary artery calcium–a review article

Iqbal¹,

Hussain²,

Iqbal³

2018

IJRRT

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Coronary artery calcium formation is an organized metabolic process which is similar to bone formation. Calcification occurs in both intima (atherosclerotic) as well as in media of coronary arteries. Inflammatory mediators and elevated lipid content within atherosclerosis are associated with intimal calcification whereas diabetes, advanced age and chronic kidney diseases (CKD) are associated with medial calcification. 14,15 Three common steps of coronary artery calcification are: a. Osteoblastic differentiation b. Bone-associated proteins formation c. Mineralization

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Aortic Unfolding Determined Using Non-Contrast Cardiac Computed Tomography: Correlations with Age and Coronary Artery Calcium Score

Cited by 7 publications

References 35 publications

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

Aortic Unfolding Measurement Using Non-Contrast Cardiac CT: Normal Range of Low-Risk Subjects

Coronary artery calcium–a review article

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